Progress in 2014, but big battles loom in 2015

It is fair to say that Medicare co-payments have dominated the media and our attention this year.

The year began with speculation about the Australian Centre for Health Research (ACHR) proposal for a $6 co-payment.

Speculation turned to shock and anger when the Government, more concerned with its budget bottom line than health care, proposed a $7 co-payment model.

From the outset the AMA argued that, while there is a place for patients to contribute to the costs of seeing their GP, the Government’s model was not the right one. It did not protect vulnerable patients, it discouraged important prevention activities and it would be an administrative nightmare. It also cut funding for GP services, despite general practice being the most cost-effective part of the health system.

After extensive AMA advocacy, Prime Minister Tony Abbott asked for an alternative proposal. The AMACGP led the development of a more cohesive model, which the AMA subsequently put to the Government.

While the Government initially labelled the AMA model a cash grab, it did take on several aspects of our alternative in the heavily revised co-payment model announced recently, including protection for residential aged care patients, other disadvantaged patients and children under 16 years. Also, co-payments for pathology and diagnostic imaging services have been dumped, along with the 10-visit safety net, lessening the red tape involved.

Despite these improvements, the Government has still failed to listen adequately to the profession. The Government’s cuts to rebates for general patients, a freeze on indexation until July 2018, and changes to Level B consultations, will bite hard.

The AMA cannot support such a significant reduction in funding for general practice, and will oppose it.

The Government has already introduced regulations to establish a 10-minute threshold for Level B consultations, which will come into effect on 19 January 2015.

GPs will have to prepare for this change as a matter of urgency.

This change cannot be reversed until Parliament next sits, and I can reassure you that the AMA will push for the change to be overturned at the first possible opportunity. It devalues general practice and undermines the viability of practices.

If the Government is able to implement its policy in full, GPs will need to re-evaluate their billing practices if they are to maintain their viability and capacity to provide quality and valued services to their patients. GPs must realise that the MBS will not be the benchmark of their value.

This year also saw the demise of Medicare Locals which, for the most part, had failed to realise their potential, largely due to their inability to engage with GPs.

The Primary Health Networks (PHNs) that will replace them may do better at this, given the requirement that they have GP-led Clinical Councils, and the Government’s objective that they must reinforce general practice as the cornerstone of integrated primary health care.

The changes to GP training announced in this year’s Budget have created much uncertainty for those contemplating general practice as a career.

While there were some positives, such as more GP registrar places, more rural GP infrastructure grants for training and a doubling of the PIP Teaching Incentive, there were negatives as well, including the disbanding of General Practice Education and Training (GPET), and the Prevocational General Practice Placement Program (PGPPP). The AMA has been pushing both GP colleges to take back responsibility for managing GP training in this new training environment.

The AMACGP has been actively working this year on a proposal to integrate pharmacists into general practice.

While we’ve been working to encourage collaboration and better patient care, it would appear that the organisations representing pharmacy owners are intent on developing new revenue streams that are not in the best interests of our patients. Pharmacy immunisation pilots, pharmacy skin checks and proposals for Government-funded pharmacy health checks are driven by self-interest and must be resisted strongly.

With private health insurers (PHIs) also looking to general practice, the AMACGP has been considering what role PHIs could play in primary health care.

The AMA is cautious in this regard, but envisages that they could work better with general practice in regard to wellness programs, the maintenance of shared electronic health care records, hospital-in-the-home arrangements, palliative care, minor procedures, and GP-directed hospital avoidance programs. This work led to the AMA’s new Position Statement on Private Health Insurance and Primary Care Services 2014.

AMA advocacy this year also resolved the bureaucratic bungle around health assessments and nurse time. GPs now have a clear statement on the circumstances in which practice nurse time can count towards a health assessment. With regard to Chronic Disease Management items, the AMA is continuing to work with the Department of Health on better targeting and streamlining the CDM items.

While this year has heralded a lot of changes, the new year will have more in store I’m sure.

As always, the AMA will be working to ensure that Government puts the interests of our patients and the profession who cares for them at the forefront of their policy development.